DEMO

CADASTRAL FICHE IC: 2160000

Personal Data
Full Name: Antonia Precavida
Sex:* Female	Date of birth:* 23/12/1983
Address: Av. do Tempo 2011
City: Rio de Janeiro	State: RJ	Country: Brasil	Postal Code: 20000-000
E-mail:	Email: ap@ap.com	Nationality:	Brazilian
Passaport
Number:	000000	Issuing country :	Brasil
Validity:	12/10/2027

Clinical Information
Weight: 55kg	Height: 1,65
Blood group:* A	RH factor:* Positive ( + )	HIV Positive: Yes
Allergies: Asthma, Antibiotic, Hives, Duster
Chronic Diseases: Diabetes, Cardiac Disorder , Circulatory Disorder, Glaucoma, Hepatitis, Hypertension, Sinusitis
Drugs of constant use: Analgesic, Antibiotic, Anticoagulant, Cortisone, Sulfa, Vitamin C
Vaccination: Cholera, Yellow Fever, Tetanus, Typhus, Smallpox, Malaria
User of: -
Contact Lens: Yes	Pacemaker: Yes	Prosthesis: Yes

In case of emergency call
Contact 1	Contact 2
Name: Maria do Socorro Ligeiro	Name: João da Ajuda
Home Phone: +55 21 24752819	Home Phone: +55 21 28784568
Business Phone: +55 21 47946135	Business Phone: +55 21 61354794
Cell Phone: +55 21 92576048	Cell Phone: +55 21 97604825
E-mail: msl@msl.com	E-mail: joao.ajuda@globo.com

Private Doctor
Doctor's Name: Dr. Antonio do Socorro Ligeiro
Home Phone: +55 21 24752819
Business Phone: +55 21 47946135
Cell Phone: +55 21 92576048
E-mail: drasl@clinicasalvavidas.com

Health Insurance
Company: Sua Saúde
Registration: 999343424
Telephone: +55 21 58481010
E-mail: pss@pss.com

Insurance Company
Company: Seguradora Azul
Policy Number: 0434-3434-3443
Telephone: +55 21 28943439
E-mail: sazul@sazul.com

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